Healthcare Provider Details

I. General information

NPI: 1003280975
Provider Name (Legal Business Name): CHARVETTE GAITONE SHUMAKER-KIRK AGACNP-; AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 LINDEN AVE NE
ATLANTA GA
30308-2951
US

IV. Provider business mailing address

7891 GABLE DR
DOUGLASVILLE GA
30135-6403
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP193221
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN193221
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN193221
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN193221
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberRN193221
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: